Actor Hayden Panettiere had been open about her mental health struggles and the challenges of being a child actor in the years prior to her death this week. 

The Heroes and Nashville actor, 36, was found unresponsive at her apartment in South Carolina on Sunday (local time), and was unable to be revived by paramedics. 

While the cause and manner of her death remain pending, dispatch audio of the call to emergency services obtained by TMZ indicated a suspected overdose.

According to her recent memoir, This Is Me: A Reckoning, Panettiere had experienced many hardships throughout her years in the public eye, including a difficult start to motherhood.

After the birth of her daughter Kaya in 2014, she haemorrhaged, requiring surgery and seven blood transfusions. When she eventually met her baby after the operation, she recalled feeling “nothing”. 

Hayden Panettiere pregnant with her daughter Kaya. Photo: Getty

In an interview with Momé, Panettiere said she began self-medicating with alcohol before seeking help and being diagnosed with postpartum depression.

She went on to speak publicly about her experience and the stigma surrounding the condition.

Following her death, some of those comments have resurfaced – including claims about the professional consequences of speaking out.

In a 2022 interview, Panettiere said skincare brand Neutrogena tried to drop her as an ambassador after she revealed she had postpartum depression.

Her comments have now attracted renewed attention, with angry fans taking to social media to call for a boycott of the brand.

Panettiere’s experience has also put the spotlight on a common but serious issue for new parents: Perinatal mental health problems, and how difficult they can sometimes be to recognise.

Narelle Dickinson, clinical and perinatal psychologist and director of Lotus Health and Psychology in Brisbane, said about one in five women experience significant anxiety or depression during pregnancy or after having a baby.

“Hayden Panettiere spoke very openly about how profoundly postnatal depression affected her sense of herself as a mother,” Dickinson said.

“She described the devastation of not feeling she could be the mother she had expected herself to be.

“That’s something I hear clinically all the time – mums experiencing an enormous discrepancy between what they thought motherhood would feel like and what they are actually experiencing.

“It is absolutely possible to desperately want a baby, love your baby and be psychologically unwell after birth, all at the same time.”

What does postnatal mental illness look like?

While postnatal depression and anxiety are relatively common, Dickinson cautioned against treating all perinatal mental health conditions as though they were the same.

“We need to be careful not to put postnatal depression, anxiety, OCD and postpartum psychosis into the same basket,” she said.

“They can overlap, but they are different presentations with different levels of risk and different treatment needs.”

Mental health conditions can overlap but still need quite different treatments.

Postpartum psychosis is much rarer, affecting around one in every 600 births. It is a psychiatric emergency requiring urgent treatment.

For families, Dickinson said one of the most useful things to watch for was simply whether something had changed.

“Ask yourself: Is this person behaving, thinking or functioning differently from the woman you know?”

Signs of postnatal depression or anxiety can include persistent low mood, excessive worry, irritability, feeling unable to cope, withdrawing from family and friends, feelings of guilt or failure, difficulty bonding with the baby and losing interest in things previously enjoyed.

Sleep can also provide clues – particularly when someone is unable to sleep even when they have the opportunity.

More concerning signs include rapid deterioration, significant agitation or confusion, paranoia, unusual or fixed beliefs, hallucinations or thoughts of suicide or harm.

But Dickinson warned there wasn’t necessarily an obvious outward sign that someone is struggling.

“A woman does not have to look obviously unwell,” she said.

“She might remain articulate, organised and outwardly functional while struggling enormously on the inside.”

How to help

Recognising that something has changed is one thing. Knowing what to do about it can be harder.

Dickinson said family and friends shouldn’t wait for someone to explicitly say they have postnatal depression before checking in.

“Ask about what you are noticing with gentle questions like: ‘You don’t seem like yourself. You’re hardly sleeping. You seem frightened. I’m worried about you’,” she said.

And rather than telling an exhausted new parent to get some rest or asking them to “let me know if you need anything”, practical help can make a significant difference.

That might mean making a GP appointment, looking after the baby while they see a health professional, bringing food or taking the baby for a few hours so the parent can get some uninterrupted sleep.

“Support shouldn’t depend upon an exhausted, frightened and unwell woman having enough executive functioning left to arrange and coordinate her own care,” Dickinson said.

If someone is rapidly deteriorating, experiencing psychotic symptoms, suicidal or there are immediate concerns about the safety of the parent or baby, urgent psychiatric or emergency assessment is needed.

For less urgent concerns, a GP, psychologist, obstetric or maternity team, child-health service or specialist perinatal mental-health service can be a starting point.

It’s not just mothers

Perinatal mental health problems aren’t limited to women who give birth.

Fathers and non-birthing parents can also experience depression, anxiety, trauma and significant difficulty adjusting after a baby arrives.

“Partners are often expected to be the support person while they themselves may be sleep-deprived, frightened and struggling,” Dickinson said.

“We need to ask how the whole family is coping, not simply assume the partner is an unlimited source of support.”

What happens after someone asks for help?

Australia has improved screening for perinatal depression and anxiety, but Dickinson said identifying someone who is struggling is only part of the equation.

“The question now is what happens after a woman tells us she isn’t okay,” she said.

“Screening questionnaires are only useful if there is somewhere for the woman to go afterwards.”

One problem is that postpartum care can be fragmented across GPs, obstetricians, child-health nurses, psychologists, psychiatrists and hospitals.

“Who is holding the whole clinical picture?” Dickinson said.

“Each individual encounter may look manageable while the trajectory across several weeks is very concerning.”

Dickinson welcomed the proposed federal inquiry into postpartum healthcare, saying Australia needed to move past thinking about care as a check-up six weeks after birth.

“We put enormous effort into safely getting women through pregnancy and birth. Once the baby arrives, the focus understandably shifts very quickly to the baby.

“But the mother hasn’t stopped being a patient.”

Dickinson says it’s important parents feel they are able to talk about postnatal mental ill health.

“Perinatal mental illness is common, it is treatable, and occasionally it can become very serious,” she said.

“Women need to be able to tell us when they are struggling without shame or fear. And when they do tell us, our healthcare system needs to be capable of responding.”